Traumas to the brain caused by outside physical forces acting on the skull or spinal cord (hereinafter, head or spine injury), ischemic stroke, Reye's syndrome, post-operative brain surgery trauma and hydrocephalus are all characterized by edema and resultant swelling. The standard treatment has been the administration of steroids, because of their known anit-inflammatory activity or procedures such as the insertion of a shunt in the case of progressive hydrocephalus. Diuretics have not found much use in the treatment of brain and spinal cord edema partly because the blood-brain barrier prevents adequate concentrations of the diuretics from reaching brain cells. Thus, any decrease in edema following diuretic administration would be a secondary or independent effect resulting from general electrolyte loss and resultant dehydration of the rest of the body. Such dehydration would be inappropriate to someone with a traumatized brain or spinal cord.
Long, et al., Dynamics of Brain Edema, pp. 293-300, Springer-Verlag (1976) described the use of the diuretics furosemide and acetazolamide for the treatment of certain models of brain edema in cats.
Bourke, et al., Brain Research, 105 (1976) 309-323 described the effect of the diuretics ethacrynic acid and acetazolamide on swelling of monkey cerebrocortical slices.